There’s no sense in simply revising the psychiatrist’s diagnostic bible: it will need to be totally replaced to fit the emerging science…

Nick Craddock is professor of psychiatry at the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff University School of Medicine, and is the director of the Welsh National Centre for Mental Health

In 1973, the American psychologist David Rosenhan sent eight healthy people, and also himself, to visit mental institutions and claim they were hearing voices. All were certified mad; some were incarcerated for a month. Rosenhan’s paper, “On Being Sane in Insane Places,” created a media sensation and a crisis in psychiatry. Doctors, it seemed, unlike suspicious fellow patients, could not tell a lucid stooge from a lunatic.

The ensuing controversy led to the tightening of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the “psychiatrists’ bible” that lists mental disorders and their symptoms. The DSM, first published in 1952, is produced by the American Psychiatric Association (APA), which, every decade or two, assembles a hundred or so mental health professionals to review disorders in the light of new science or shifting cultural norms…

Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM 5. With her journalist’s instinct for the crux of any story, Dr. Rockwell has focused on increasing public scrutiny of DSM 5. She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:

You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn’t mention, one that could be even more powerful. Don’t discount the role of government intervention as a way of influencing the American Psychiatric Association.

I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM 5 and to recruit government assistance in forcing APA to abandon dangerous suggestions.

I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: 1) raising the percentage of our citizens who are considered to be mentally ill — they are surprised to learn that it is already an astounding 50% lifetime; 2) increasing the cost of drug treatments and their harmful side effects; 3) pulling scarce mental health resources away from those who are really ill and most need them; 4) distorting benefit determinations for insurance, disability, compensation, and school services; and 5) creating great confusion in the courts.

The people I speak to all quickly understand the public health and public policy significance of DSM 5 and that government has a big stake in making it safe.

I am especially reaching out to the HELP (Health, Education, Labor & Pensions) committee chaired by Sen. Tom Harkin (D-IA), which oversees mental health issues and to Sen. Charles Grassley (R-IA), who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations — children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.

I use concrete examples to get my points across. Most alarming, that DSM 5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM 5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM 5 will turn normal grief into depression. And DSM 5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM 5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.

The general public can help by calling or emailing congressional representatives to request protection from DSM 5. People should demand that DSM 5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation’s mental health from the excesses of DSM 5.

I do wonder how loudly must the public and the professional mental health community shout, “Stop!”, before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people.”

As I read this, I find it both sad and silly that DSM 5 has allowed things to degenerate to the point where government intervention may indeed be necessary. DSM 5 has stubbornly ignored the general consensus that many of its suggestions simply make no sense and may cause grave damage both to public health and public policy. The DSM 5 hot potato suggestions should have been dropped long ago. They certainly must be rejected now.

Adding a new diagnoses in psychiatry can be far more dangerous than approving one of the new “me-too” drugs that so often come to market. It is paradoxical and nonsensical for us to carefully vet new drugs through a fairly rigorous FDA procedure but at the same time allow new diagnoses to be introduced through a badly flawed decision-making process completely controlled by just one professional organization that has lost its credibility. The new diagnoses suggested by DSM 5 will lead to widespread misdiagnosis and inappropriate drug use — causing far more damage than could possible be wrought by any new “me-too” drug.

To date, APA has failed to provide appropriate governance. DSM 5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.

Over 12,000 individuals and organizations have now signed the Coalition for DSM-5 Reform petition

Please note the Coalition for DSM-5 Reform petition is intended for endorsement by mental health organizations and professional bodies and for signing by mental health professionalsnot intended for signing by patients.

Dx Revision Watch has no connection with the Coalition for DSM-5 Reform, its Open Letter initiative or associated petition. All enquiries relating to the Coalition for DSM-5 Reform should be addressed directly to Dr David Elkins, Ph.D., Chair, Coalition for DSM-5 Reform committee.